only kill the cancer cells, but also kill the gut microbes
as well. That conflict of killing off things that give
you energy leads to fatigue.

This condition is not limited to cancer patients, as
it also affects those suffering from such gastrointesti-
nal maladies as inflammatory bowel disease, bacterial
infections and chronic diarrhea. A fecal transplant is
one of the most effective ways to treat these condi-
tions, as the new bacteria transplanted into the patient
fights off the bad microbes and reestablishes the good
ones. It s one of the most remarkable things I ve seen
in science, says Dr. Morrow. The procedure has a
90 percent success rate. Within 24 to 48 hours, these
patients are up walking around and having normal
bowel movements, which they haven t had in years.

There are two other areas related to the microbiome
that UAB researchers are currently studying. One is
the oral cavity, which contains anywhere between 500
to 650 different species of bacteria around 20 billion
microbes. Variances in the oral microbiome, which
would include the mouth, teeth, saliva and tongue, can
provide indications of potential oral cancers.

The other major area being studied is the skin.
Scientists have identified more than 200 different spe-
cies of bacteria that live on the skin, with the forearms
having the most diverse microbes, but the nostrils, ears
and the area between the legs and groin having the
most stable environments.

Microbiome researchers at UAB have begun
studies with Craig Elmets, M.D., chair of the UAB
Department of Dermatology and Cancer Center senior
scientist, on the impact of ultraviolet (UV) radiation on
the skin and the microbiome. When skin cells are dam-
aged by UV radiation, they die to be replaced by new
skin cells, or they can possibly become cancerous. Dr.
Elmets and his group are examining how skin microbes
respond to these damaged skin cells as well as the new
skin cells, and how this impacts the human host.

While the oral cavity, the gut and skin comprise the
majority of UAB s microbiome research, there are ongo-
ing projects in other areas as well. Researchers in the
Department of Infectious Diseases are examining the
microbiome s impact on sexually transmitted diseases
and the vaginal tract. Physician-scientists in the UAB

microbes there to see which might be predictors for
early carcinogenesis or developments of cancer.

All of this work is being done with the goal of
developing a microbiome management program , where
we can interact with the scientists and physicians who
want to do these studies, Dr. Morrow says. We want
to encourage them to incorporate sample collections for
microbiome data into their research projects, so that we
can provide them with output data for their studies.

The Impact of the Microbiome

Knowing that microbes are everywhere, the pri-
mary question scientists must now ask is what impact
certain microbes have. That question will be answered
over several phases, Dr. Morrow says. The first phase
is to understand what microbes are present normally.
The second is to look at what remains after disease
or as a result of disease. The big question is do the
microbes cause that disease, or do they respond to the
host having that disease?